=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679758882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LVA QUALITY HOME HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2008
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 SANDALWOOD LN
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-4269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-228-4705
-----------------------------------------------------
Fax | 972-217-9304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1113 SANDALWOOD LN
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-4269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-228-4705
-----------------------------------------------------
Fax | 972-217-9304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MIGDALIA ESTER DAVIES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-335-2902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------